Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y
Department of Obstetrics and Gynecology, Chiba University School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba 260-8670, Japan.
Hum Reprod. 2000 Mar;15(3):608-11. doi: 10.1093/humrep/15.3.608.
A national collaborative study was conducted in Japan to evaluate the clinical course and the sequelae of patients with hydatidiform mole coexistent with twin live fetus (HMTF). Seventy-two cases of HMTF were diagnosed based on gross appearance and histopathological criteria. In 18 cases, the molar parts were cytogenetically confirmed to be of androgenetic origin (complete mole). The overall incidence of persistent trophoblastic tumour (PTT) in patients with HMTF was 30.6%, and it increased to 50.0% in the 18 patients with proven androgenetic complete mole coexistent with twin live fetus (CHMTF). Among these patients, the mean gestational age at termination of pregnancy or delivery in those who developed PTT (n = 9) and those who did not (n = 9) were 20.6 and 19.4 weeks respectively. The incidence of severe maternal complications was significantly higher in patients who subsequently developed PTT (P < 0.05). The rate of subsequent development of PTT in patients with CHMTF was found to be considerably higher than in a previous study of patients with single complete mole (50 and 12.5% respectively). However, since the risk of malignancy is unchanged with advancement of gestational age, continued pregnancy may be allowed in patients with HMTF provided that severe maternal complications are controlled and fetal karyotype and development are normal.
日本开展了一项全国性合作研究，以评估葡萄胎合并双活胎（HMTF）患者的临床病程及后遗症。根据大体外观和组织病理学标准诊断出72例HMTF。其中18例的葡萄胎部分经细胞遗传学证实为雄激素来源（完全性葡萄胎）。HMTF患者持续性滋养细胞肿瘤（PTT）的总体发生率为30.6%，在18例经证实为雄激素来源的完全性葡萄胎合并双活胎（CHMTF）患者中，这一发生率增至50.0%。在这些患者中，发生PTT的患者（n = 9）和未发生PTT的患者（n = 9）终止妊娠或分娩时的平均孕周分别为20.6周和19.4周。随后发生PTT的患者严重母体并发症的发生率显著更高（P < 0.05）。发现CHMTF患者PTT的后续发生率明显高于先前对单发性完全性葡萄胎患者的研究（分别为50%和12.5%）。然而，由于随着孕周增加恶性风险不变，只要能控制严重母体并发症且胎儿核型及发育正常，HMTF患者可继续妊娠。
